SIU Investigator

This is a fully remote position, open to applicants in Florida.

📋 Description

• Investigate claims of possible healthcare fraud and abuse activities.

• Aid in the planning, organization, and execution of claims investigations or audits aimed at identifying, assessing, and quantifying potential healthcare fraud and abuse.

• Conduct inquiries into possible waste, abuse, and fraud.

• Record activity for each case and escalate issues to the relevant parties.

• Execute data mining and analysis to uncover irregularities and outliers in claims.

• Create new queries and reports to identify potential waste, abuse, and fraud.

• Provide updates on case progress for investigations and collaborate with Health Plans on recommendations, further actions, and resolutions.

• Assist with intricate allegations of healthcare fraud.

• Prepare summary and/or comprehensive reports on investigative outcomes for referral to Federal and State agencies.

• Complete various special projects and audits.

• Perform additional duties as assigned and adhere to all policies and standards.

⛳️ Requirements

• A Bachelor's Degree in Business, Criminal Justice, Healthcare, or a related field, or equivalent experience is mandatory.

• A minimum of 1 year of experience in medical claim investigation, medical claim audit, medical claim analysis, or fraud investigation is required.

🏝️ Benefits

• Competitive pay.

• Health insurance.

• 401K and stock purchase plans.

• Tuition reimbursement.

• Paid time off plus holidays.

• Flexible work arrangements with remote, hybrid, field, or office schedules.